Plating technology has reached its 4th generation, evolving to locking plate constructs. This system provides little to no contact with the bone, thus preserving blood supply and the periosteum. The screw to plate construct provides a fixed angle, yielding more stability and resistance to pull out.
From a mechanical standpoint, the plate is best utilized and functions the best when placed on the tension side of the bone. In case of foot surgery, this is most often on the plantar surface. Additionally, this construct may facilitate improved healing and earlier weight bearing.
Current systems in foot and ankle surgery include plates or supporting structures that are utilized or located dorsally and on the sides of the bone, primarily due to anatomical constraints. While the plate can be placed plantarly, difficulties arise when placing screws from the bottom as designed. This difficulty stems from the concentration of neurovascular structures on the tension side of the bone and surgical exposure. Furthermore, in current systems, the head of the screw will attach to the plate. This attachment technique requires undesirable dissection and/or exposure of the arteries and nerves on the tension side of the bone.